Effectiveness and cost of quick diagnostic tests to determine tetanus immunity in patients with a wound in french emergency departments

Abstract Introduction All patients presenting to emergency departments (EDs) with traumatic injuries require tetanus immunity assessments. Inaccurate tetanus vaccination history based on patient recall incurs unnecessary costs on the NHS. Point-of-care immunochromatographic tests (Tetanus Quick Sticks [TQS]) quickly identify tetanus immunity status. We aim to evaluate the diagnostic accuracy and cost-efficacy of TQS to assess their relevance in emergency care. Method The systematic review followed PRISMA guidelines. A retrospective search of MEDLINE, Embase, Global Health, HMIC and The Cochrane Library was conducted. Studies were eligible if sensitivity, specificity, or cost-efficacy of TQS were reported. At least two authors independently analysed the data from each study. Results 12 studies were suitable for inclusion (n = 1,662,865 participants): one retrospective and 11 prospective observational cohort studies. Eight studies assessed diagnostic accuracy with the median sensitivity at 86% (55-100) and the median specificity at 97.5% (1-100). All six studies investigating cost-efficacy reported greater savings when using TQS instead of using vaccination history, due to a decrease in unnecessary tetanus vaccine and immunoglobulin administration. Conclusions TQS is a safe diagnostic tool, especially when used by trained operators. TQS widely reduces costs in comparison to traditional vaccination history. We recommend the use of TQS in Emergency Departments throughout the NHS.

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Highlighting the rules between diagnosis types and laboratory diagnostic tests for patients of an emergency department: Use of association rule mining

Health Informatics Journal ◽

10.1177/1460458219871135 ◽

2019 ◽

Vol 26 (2) ◽

pp. 1177-1193

Author(s):

Görkem Sarıyer ◽

Ceren Öcal Taşar

Keyword(s):

Emergency Department ◽

Diagnostic Test ◽

Association Rule ◽

Emergency Departments ◽

Diagnostic Tests ◽

Association Rule Mining ◽

Real Life ◽

Rule Mining ◽

International Classification Of Disease ◽

Use Of Resources

Diagnostic tests are widely used in emergency departments to make detailed investigations on diagnosis and treat patients correctly. However, since these tests are expensive and time-consuming, ordering correct tests for patients is crucial for efficient use of hospital resources. Thus, understanding the relation between diagnosis and diagnostic test requirement becomes an important issue in emergency departments. Association rule mining was used to extract hidden patterns and relation between diagnosis and diagnostic test requirement in real-life medical data received from an emergency department. Apriori was used as an association rule mining algorithm. Diagnosis was grouped into 21 categories based on International Classification of Disease, and laboratory tests were grouped into four main categories (hemogram, biochemistry, cardiac enzyme, urine and human excrement related). Both positive and negative rules were discovered. Since the nature of the data had the dominance of negative values, higher number of negative rules with higher confidences were discovered compared to positive ones. The extracted rules were validated by emergency department experts and practitioners. It was concluded that understanding the association between patient’s diagnosis and diagnostic test requirement can improve decision-making and efficient use of resources in emergency departments. Association rules can also be used for supporting physicians to treat patients.

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Testing for the Role of Prejudice in Emergency Departments Using Bounceback Rates

The B E Journal of Economic Analysis & Policy ◽

10.1515/1935-1682.3247 ◽

2012 ◽

Vol 12 (3) ◽

Cited By ~ 1

Author(s):

Shamena Anwar ◽

Hanming Fang

Keyword(s):

Emergency Department ◽

New Jersey ◽

Administrative Data ◽

Emergency Departments ◽

Diagnostic Tests ◽

Racial Prejudice ◽

Hispanic Patients ◽

Ed Visits ◽

Male Patients

Abstract We propose and empirically implement a test for the presence of racial prejudice among emergency department (ED) physicians based on the bounceback rates of patients discharged after receiving diagnostic tests during their initial ED visit. A bounceback is defined as a return to the ED within 72 hours of being initially discharged. Applying the test to administrative data of ED visits from California and New Jersey, we do not find evidence of prejudice against black and Hispanic patients, but we find evidence of prejudice against Asians in California. We also find evidence of prejudice against male patients.

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Clinical decision analysis methods applied to diagnostic tests in dentistry

Journal of Dental Education ◽

10.1002/j.0022-0337.1983.47.11.tb01729.x ◽

1983 ◽

Vol 47 (11) ◽

pp. 708-714 ◽

Cited By ~ 12

Author(s):

CW Douglass ◽

BJ McNeil

Keyword(s):

Decision Analysis ◽

Diagnostic Tests ◽

Clinical Decision ◽

Analysis Methods

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Images of Aging in the Psychotherapeutic Context

GeroPsych ◽

10.1024/1662-9647/a000129 ◽

2015 ◽

Vol 28 (2) ◽

pp. 47-55 ◽

Cited By ~ 10

Author(s):

Eva-Marie Kessler ◽

Catherine E. Bowen

Keyword(s):

Old Age ◽

Diagnostic Tests ◽

Aging Process ◽

Developmental Psychology ◽

Mental Representations ◽

Later Life ◽

Future Research ◽

Psychotherapeutic Process ◽

Images Of Aging ◽

Client Communication

Both psychotherapists and their clients have mental representations of old age and the aging process. In this conceptual review, we draw on available research from gerontology, social and developmental psychology, and communication science to consider how these “images of aging” may affect the psychotherapeutic process with older clients. On the basis of selected empirical findings we hypothesize that such images may affect the pathways to psychotherapy in later life, therapist-client communication, client performance on diagnostic tests as well as how therapists select and apply a therapeutic method. We posit that interventions to help both older clients and therapists to reflect on their own images of aging may increase the likelihood of successful treatment. We conclude by making suggestions for future research.

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Emergency Departments Are Underutilized Sites for Suicide Prevention

Crisis ◽

10.1027/0227-5910/a000001 ◽

2010 ◽

Vol 31 (1) ◽

pp. 1-6 ◽

Cited By ~ 62

Author(s):

Gregory Luke Larkin ◽

Annette L. Beautrais

Keyword(s):

Suicide Prevention ◽

Emergency Departments

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Suicidal Behavior and Non-Suicidal Self-Injury in Emergency Departments Underestimated by Administrative Claims Data

Crisis ◽

10.1027/0227-5910/a000499 ◽

2018 ◽

Vol 39 (5) ◽

pp. 318-325 ◽

Cited By ~ 8

Author(s):

Barbara Stanley ◽

Glenn W. Currier ◽

Megan Chesin ◽

Sadia Chaudhury ◽

Shari Jager-Hyman ◽

...

Keyword(s):

Emergency Departments ◽

Suicide Attempts ◽

The United States ◽

Administrative Claims ◽

Suicide Attempters ◽

Self Injury ◽

Axis I ◽

Ed Visits ◽

External Causes ◽

Severe Psychopathology

Abstract. Background: External causes of injury codes (E-codes) are used in administrative and claims databases for billing and often employed to estimate the number of self-injury visits to emergency departments (EDs). Aims: This study assessed the accuracy of E-codes using standardized, independently administered research assessments at the time of ED visits. Method: We recruited 254 patients at three psychiatric emergency departments in the United States between 2007 and 2011, who completed research assessments after presenting for suicide-related concerns and were classified as suicide attempters (50.4%, n = 128), nonsuicidal self-injurers (11.8%, n = 30), psychiatric controls (29.9%, n = 76), or interrupted suicide attempters (7.8%, n = 20). These classifications were compared with their E-code classifications. Results: Of the participants, 21.7% (55/254) received an E-code. In all, 36.7% of research-classified suicide attempters and 26.7% of research-classified nonsuicidal self-injurers received self-inflicted injury E-codes. Those who did not receive an E-code but should have based on the research assessments had more severe psychopathology, more Axis I diagnoses, more suicide attempts, and greater suicidal ideation. Limitations: The sample came from three large academic medical centers and these findings may not be generalizable to all EDs. Conclusion: The frequency of ED visits for self-inflicted injury is much greater than current figures indicate and should be increased threefold.

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